Results of one-year anticoagulation in patients with newly detected chronic thromboembolic pulmonary hypertension not treated with pulmonary endarterectomy.

INTRODUCTION: Currently pulmonary endarterectomy is considered the method of choice in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is not known if this option should be recommended in all suitable patients as it is highly variable with respect to prognosis. There is also doubt about selection of adequate time to refer patients with CTEPH for surgery. AIM: To establish whether some patients with CTEPH may clinically benefit from isolated anticoagulation with drugs and if the use of anticoagulation may have any impact on the time of patient referral for pulmonary endarterectomy. METHODS: The prospective analysis involved 29 patients (9 male, 20 female) aged 37 to 82 years, with pulmonary arterial systolic pressure ranging from 39 to 133 mmHg and newly diagnosed CTEPH who had not been treated with pulmonary endarterectomy and were not receiving anticoagulation. Survival, functional status according to NYHA classification, duration of thromboembolism, exercise tolerance and echocardiographic parameters of right ventricular overload before and at one year after initiation of therapy with anticoagulants were evaluated. RESULTS: During follow-up, 3 patients with PASP ranging from 120 to 133 mmHg died. In 26 patients with PASP 39-115 mmHg, who survived, improvement in echocardiographic parameters of right ventricular overload, better exercise tolerance as well as functional status according to NYHA classification was observed. In 12 survivors, pulmonary pressure returned to normal. CONCLUSIONS: The results of this study suggest that favourable effects of isolated anticoagulation are likely in patients with newly detected CTEPH, mild and moderate baseline pulmonary hypertension and acceptable exercise tolerance. They also indicate the necessity of anticoagulation in these patients prior to possible referral for pulmonary endarterectomy.

[Coronary angiography is not always helpful in differential diagnosis between perimyocarditis and myocardial infarction - four case reports]. / Czy zmiany ST-T elektrokardiogramu sa wynikiem zapalenia osierdzia i miesnia sercowego - czy zawalu serca. Koronarografia nie zawsze rozstrzyga watpliwosc. Opis 4 przypadków.

Four males aged 17-42 years with ST-T segment changes suggesting perimyocarditis or non-Q acute myocardial infarction are presented. Coronary angiography was performed to establish the final diagnosis. Three patients had normal coronary arteries; two of them had typical clinical signs of perimyocarditis whereas the third patient had less typical changes. The fourth patient was a smoker, had a family history of coronary heart disease and left ventricular dysfunction due to a non-Q wave apical infarction. In this patient coronary angiography revealed small atheromatous plaques in the distal part of left anterior descending artery as well as left main and right coronary artery spasm. Angiospastic aetiology of infarction and probable endothelial dysfunction due to myocarditis were diagnosed. The authors conclude that coronary angiography is not always helpful if clinical, electrocardiographic and biochemical signs of perimyocarditis are observed.

[Infective endocarditis--still a great challenge. Two case reports]. / Infekcyjne zapalenie wsierdzia - wciaz wielkie wyzwanie. Opis dwóch przypadków.

We present two patients with aortic valve disease who developed acute infective endocarditis. In both patients the disease started with infection of the upper respiratory tract. The patients were treated with antibiotics due to pneumonia. The diagnosis of infective endocarditis was established 4 months and 9 weeks after the onset of infection. The first patient died whereas the second underwent successful aortic valve replacement.